Baseline Sattler Layer–choriocapillaris Complex Thickness Cutoffs Associated With Age-Related Macular Degeneration Progression

Abstract

To assess the relationship between choroidal overall and sublayer thickness and age-related macular degeneration (AMD) stage progression.Methods: A prospective, observational case series was performed. Two hundred and sixty-two eyes of 262 patients with different stages of AMD were imaged by optical coherence tomography. Age-related macular degeneration stage, choroidal thickness, Sattler layer-choriocapillaris complex thickness (SLCCT), and Haller layer thickness were determined at the baseline visit, at a 1-year follow-up visit, at a 2-year follow up visit, and at a final visit (performed after a mean of 5 ± 1 year from the baseline visit).Results: Baseline AMD stages were distributed as follows: early AMD (30 eyes; 12%), intermediate AMD (97 eyes; 39%), and late AMD (126 eyes; 49%). At the final follow-up, AMD stages were so distributed: early AMD (14 eyes; 6%), intermediate AMD (83 eyes; 33%), and late AMD (156 eyes; 61%). Each group showed a statistically significant decrease in choroidal thickness values over the entire follow-up (P , 0.001), and SLCCT reduction was associated with AMD progression (P , 0.001). Moreover, SLCCT quantitative cutoffs of ,20.50 mm and ,10.5 mm were associated with a moderate and high probability of AMD progression, respectively, and SLCCT quantitative cutoffs of ,18.50 mm and ,8.50 mm implied a moderate and high probability of macular neovascularization onset, respectively.Conclusion: Progressive choroidal impairment contributes to AMD progression. Among choroidal layers, a reduced SLCCT is a promising biomarker of disease worsening, and its quantitative evaluation could help to identify patients at higher risk of stage advancement.

Quantitative multimodal imaging of extensive macular atrophy with pseudodrusen and geographic atrophy with diffuse trickling pattern

“…Recently, an association between CVI and GA growth has been reported 10 . Our research group also found that choroidal thinning takes place predominantly in the Sattler layer-choriocapillaris complex 11 .…”

“…Subfoveal and mean choroidal thickness (CT), Haller layer thickness (HLT) and Sattler layer-choriocapillaris complex thicknesses (SLCCT), and choroidal vascularity index (CVI) at baseline and at the end of the follow-up were measured on OCT B-scans centered on the fovea, in accordance with the current literature 11 , 20 , 21 . Large choroidal vessels defined the Haller layer, whereas SLCCT was defined as the distance between the lower border of the retinal pigment epithelium–Bruch complex and the upper border of the Haller layer, as previously reported 11 .…”

“…EMAP). Recently, the the choroid has also been implicated in GA progression 10 , 11 , but its modifications in different macular atrophy patterns, as well as in EMAP, have not been thoroughly examined.…”

Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration

“…Choroidal thickness is thinner in patients with AMD than in those without retinal pathology [ 86 ]. In one study, reduction in the choriocapillaris complex thickness was significantly associated with AMD progression over 5 years of follow-up ( p < 0.001): a thickness of < 10.5 µm was associated with a high probability of progression, whereas a thickness of > 10.5 but < 20.5 µm was associated with moderate probability [ 87 ]. However, the relationship between choroidal thickness and AMD status is affected by several other factors, such as axial length, age, and possibly the presence of RPD, which complicates the reported associations [ 86 , 88 ].…”